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Randomized controlled trial of room air vs. 80% oxygen for induction of neonatal anesthesia: Feasibility and safety
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.ORCID iD: 0000-0003-0407-2143
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
(English)Manuscript (preprint) (Other academic)
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:uu:diva-352666OAI: oai:DiVA.org:uu-352666DiVA, id: diva2:1214434
Available from: 2018-06-06 Created: 2018-06-06 Last updated: 2018-06-27
In thesis
1. Aspects of neonatal intensive care and anesthesia: Thermal balance and respiratory management
Open this publication in new window or tab >>Aspects of neonatal intensive care and anesthesia: Thermal balance and respiratory management
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is based on four articles originating from three studies conducted in the neonatal intensive care unit and the children’s operating deparment at Uppsala University Hospital, Sweden.

The overall aim was to obtain new knowledge about thermal balance and care environment in extremely preterm infants during skin-to-skin care (SSC), evaluate different methods of intraoperative monitoring of carbon dioxide (CO2), and to investigate how different levels of inhaled oxygen affect infants’ oxygenation during anesthesia and surgery. Study I investigated infant thermal balance and the physical environment for extremely preterm infants during SSC. Study II formed part of a prospective study to assess the performance of non-invasive transcutaneous and end-tidal technique to continuously monitor CO2 levels in the infants blood during anesthesia. Study III was a prospective randomized trial to investigate oxygenation during induction of anesthesia with room air versus high fraction (80%) of oxygen in healthy newborn infants.

The infants maintained normal body temperature during SSC. In comparison to care in an incubator, during SSC ambient humidity was lower and insensible water loss through the skin was higher. Compared to blood gas Pco, transcutaneous carbon dioxide monitoring yielded a bias of 0.3 ± 0.7 kPa, and end-tidal technique a bias of -1.9 ± 0.9 kPa. After intubation, saturation measured by pulse oximetry was lower (p < .05) in the group breathing room air than in the group with high oxygen (93% ± 6.7 and 99% ± 1.5). None of the infants spent time below the pre-specified safety oxygen saturation targets to mandate supplemental oxygen.

This thesis provides new knowledge about early initiation of SSC after birth for extremely preterm infants, the results will be useful to guide safe routines for implementation of early SSC. These results suggest that during anesthesia would transcutaneous monitoring of carbon dioxide be beneficial, end-tidal monitoring correlated poorly to blood gas and induction of general anesthesia in newborn infants can be safely performed without the use of high levels of supplemental oxygen. Taken together, this new knowledge has the potential to improve intraoperative respiratory management.

Place, publisher, year, edition, pages
uppsala: Acta Universitatis Upsaliensis, 2018. p. 46
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1475
Keywords
Neonatal, anesthesia, kangaroo-mother-care, skin-to-skin care, carbon dioxide
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-352668 (URN)978-91-513-0375-8 (ISBN)
Public defence
2018-09-14, Rosensalen, Akademiska sjukhuset Ingång 95/96, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-08-24 Created: 2018-06-27 Last updated: 2018-09-07Bibliographically approved

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Karlsson, VictoriaFredén, FilipÅgren, Johan

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Anaesthesiology and Intensive CareDepartment of Women's and Children's HealthPerinatal, Neonatal and Pediatric Cardiology Research
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